The quality of evidence is downgraded by study limitations (lack of allocation concealment and blinding) and by indirectness (differences between the outcomes of interest and those reported).
A Cochrane review [Abstract] 1 included 77 studies with a total of 6753 participants to assess the beneficial and harmful effects of herbal medicines for people with fatty liver disease. Both alcoholic and non-alcoholic (NAFLD) fatty liver etiologies were considered. Prevalence of NAFLD in study populations varied between 12 to 46%.
Herbal medicines were defined as a product derived from medicinal plants. The most commonly used herbs were Crataegus pinnatifida, Salvia miltiorrhiza, Alisma orientalis, Bupleurum chinense, Cassia obtusifolia, Astragalus membranaceous, and Rheum palmatum. Altogether 75 different herbal medicine products were tested. Herbal medicines tested included single-herb products, proprietary herbal medicines commercially available, and combination formulas prescribed by practitioners.
Most trials reported positive effects on some putative surrogate outcomes such as serum aspartate aminotransferase, alanine aminotransferase, glutamyltransferase, alkaline phosphatases, ultrasound, and computed tomography scan. Six herbal medicines in five studies showed statistically significant beneficial effects on ultrasound, four on liver computed tomography, 42 on aspartate aminotransferase activity, 49 on alanine aminotransferase activity, three on alkaline phosphatases activity, and 32 on glutamyltransferase activity compared with control interventions. A pooled analysis could not be performed. No significant difference on adverse effects between herbal medicine and control groups was found.
A number of herbal medicinal products are also associated with a spectrum of hepatotoxicity events.
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